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. 2023 Jan 6:10:1070231.
doi: 10.3389/fpubh.2022.1070231. eCollection 2022.

Short-term exposure to ozone and asthma exacerbation in adults: A longitudinal study in China

Affiliations

Short-term exposure to ozone and asthma exacerbation in adults: A longitudinal study in China

Xinyi Fang et al. Front Public Health. .

Abstract

Background: The relationships between short-term ozone exposure and the acute exacerbations of asthma in adults have not been fully studied. Existing studies commonly ignored the effects of ozone on mild or early asthma exacerbations.

Objective: To investigate the associations between short-term ozone exposure and asthma exacerbations in Chinese adults.

Methods: We administered health management for adult asthma patients through the Respiratory Home Platform and required them to monitor their lung function every morning and evening by themselves. Finally, a total of 4,467 patients in 18 Chinese cities were included in the current analyses, with 79,217 pairs of lung function records. The maximum daily 8-h average ozone concentrations were collected from fixed-site air quality monitoring stations. We calculated diurnal peak expiratory flow (PEF) variation using morning and evening measurements of PEF and then defined different severity of asthma exacerbations with diurnal PEF variations >10, 15, and 20%, respectively. A binomial distributed generalized additive mixture model combined with distribution non-linear models was applied to examine the association of ozone with asthma exacerbations. We further conducted stratified analyses by sex, age, season of lung function tests, and region.

Measurements and results: We found that short-term ozone exposure was independently associated with an elevated risk of asthma exacerbations defined by lung function and the effects could last for about 2 days. At lag 0-2 days, each 10 μg/m3 increment in ozone concentration was associated with odds ratios of 1.010 [95% confidence interval (CI): 1.003, 1.017], 1.014 (95% CI: 1.005, 1.023), and 1.017 (95% CI: 1.006, 1.028) for asthma exacerbations that were defined by diurnal PEF variation over 10, 15, and 20%, respectively. The associations remained significant after adjusting for other pollutants, and became unstable when using 24-h average ozone concentration. We also found that the associations were relatively stronger in males, those aged 45 years and older, and in the warm season.

Conclusions: Our results suggest that short-term ozone exposure can increase the risk of asthma exacerbations, even in the early stage of exacerbation. Male and older asthma patients may be more vulnerable to ozone air pollution, especially in the warm season.

Keywords: asthma exacerbation; diurnal peak expiratory flow variation; longitudinal study; lung function; ozone.

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Conflict of interest statement

SH was employed by Guangzhou Homesun Medical Technology Co. Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the inclusion and exclusion of adult asthma patients.
Figure 2
Figure 2
Lag patterns for the associations between ozone and asthma exacerbations defined by diurnal peak expiratory flow variation over 10% (A), 15% (B), and 20% (C). The solid lines and shaded areas represent odds ratios and the 95% confidence intervals, respectively.
Figure 3
Figure 3
Cumulative exposure-response curves for the associations between ozone concentration and asthma exacerbations defined by diurnal peak expiratory flow variation over 10% (A), 15% (B), and 20% (C), over lag 0–2 days. The solid lines and shaded areas represent odds ratios and the 95% confidence intervals, respectively.

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